Provider Demographics
NPI:1013193002
Name:HARTTER, DAVID (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HARTTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 FORT ST
Mailing Address - Street 2:PHARMACY
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4601
Mailing Address - Country:US
Mailing Address - Phone:734-671-3839
Mailing Address - Fax:734-642-2070
Practice Address - Street 1:159 KERCHEVAL AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3610
Practice Address - Country:US
Practice Address - Phone:313-640-2482
Practice Address - Fax:313-343-8657
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist